inside president’s message · (report of the reference committee, 2016). (all of the bullet...
TRANSCRIPT
VOLUME 61 • NUMBER 4 OCTOBER 2016
Quarterly publication direct mailed to more than 25,000 Registered Nurses and Licensed Practical Nurses in New Mexico. Provided to New Mexico’s Nursing Community by the New Mexico Nurses Association
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Leigh DeRoos MSN, RNPresident New Mexico Nurses Association
Hundreds of nurses from across the country and US territories met in Washington, DC in June, 2016 for the annual American Nurses Association (ANA) Membership Assembly. One highlight of the Membership Assembly was the Dialogue Forums, with oversight provided by ANA’s Reference Committee. Some of the Reference Committee’s responsibilities include providing hearings on proposals (Dialogue Forums) for Membership Assembly and they may also recommend to the ANA Board actions to take on proposals put forth at Membership Assembly. This sanctioned activity by the Reference Committee gives nurses a significant voice in bringing to the attention of delegates and ANA’s governing body concerns that impact nurses and their practice. Discussions by the delegates occurred on each topic and the Reference Committee made recommendations for action on these topics to the delegates and the ANA Board. These topics have the potential to become position papers by ANA. These are your elected delegates at the table developing policies that have the potential for impacting all nurses. Having attended the Membership Assembly as one of your elected representatives let me report on these Dialogue Forums.
The two topics presented this year were Dialogue Forum #1: Nursing Advocacy for Sexual Minority and Gender Diverse Populations, and Dialogue Forum #2: Gender Diverse Populations and Dealing with Substance Use Disorder in Nursing. Dialogue Forum #1 noted that the issues surrounding health disparities are well-documented in our health care system. As nurses, we are confronted with health disparities in our practice in providing needed and appropriate care for our patients. However, the LGBTQ community
believes they have barriers linked to social, economic and environmental disadvantages, and structural barriers including biases in health care professionals. Referencing ANA’s Code of Ethics, the interpretive statements note that “the need for and right to health care is universal and inclusive of different cultures, values, and preferences of the individual patient, family, group, community, and populations (American Nurses Association, 2015). We know that nurses are uniquely positioned to “identify and address barriers to health care” (Report of the Reference Committee, 2016). (All of the bullet points below are taken verbatim from the Report of the Reference Committee, 2016.)
President’s MessageAmerican Nurses Association 2016 Membership Assembly
Your Voice – A Report on the Dialogue ForumsParticipant comments on Dialogue Forum
#1 were:• The need to ensure that written and electronic
documentation is gender and relationship neutral. This would facilitate data capture that could be used to support nursing research.
• The need for additions to nursing curriculum andprofessional development that speaks to the specific cultural and health concerns within each group of the LGBTQ community.
• TheneedtomainstreamthecareofmembersoftheLGBTQ community into the health care experience.
• Theneedforstandardizedterminology toenhancenurses’ communication with patients and families. There was recognition that any terminology would need to evolve.
• Thenotionthatifamistakeismade,thereisaneedto apologize and own it. Itwas also noted that a“safe place” is needed to allow for open and frank dialogue.
• The need for neutral communication strategies tosupport nurses as they approach a patient/client/family interaction.
• That conscious and unconscious bias influencescare. One suggestion was to consider applying a “universal precautions” approach to all patients.
• Theneedtomonitorand/orupdatelocal,stateandfederal law and organizational policies to ensurenon-discriminatory, family-friendly, gender identity policies.
• The need to hear the varied perspectives ofdifferent generations (e.g. millennials) of nurses on the nursing care needs of members of the LGBTQ community.
• The President of the National Student NursesAssociation (NSNA) noted that NSNA has several position statements that speak to care and the LGBTQ community.
• The need for patient education materials to bedeveloped that address the unique needs of the LGBTQ community.
The Reference Committee reported to the Membership Assembly after the discussion on Dialogue Forum #1 and made the following recommendations:
• Promote the application of ANA’s Code of Ethics for Nurses with Interpretive Statements to ensure
President’s Message continued on page 3
Healthy Nurse, Healthy New MexicoPages 4-5
Register Now and Attend!Page 6
Student ForumPage 10
New Mexico Nurses Association
ANNUAL MEETING
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Page 2 • The New Mexico Nurse October, November, December 2016
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President: Leigh DeRoos, MSN, RN4644 Sandalwood Drive Las Cruces, NM 88011Hm: 575-521-4362 [email protected]: 575-496-6924 term exp. 2015
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Camille Adair, RN Chair of Healthy Nurse, Healthy NM
Jason Bloomer, RN, BSN Chair, Welcome to the Profession
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Christine DeLucas, DNP, MPH RN Chair, Government Relations Committee
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Acceptance of advertising does not imply endorsement or approval by the New Mexico Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. NMNA and the ArthurL.DavisPublishingAgency,Inc.shallnotbeheldliable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of NMNA or those of the national or local associations.
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unwavering, culturally sensitive, unbiased and non-discriminatory care of members of the LGBTQ community.
• Promotestrategiestoeducatenursesaboutthepotentialimpactofpersonalbias,whether conscious or unconscious, on patient care particularly as it relates to care of individuals within the LGBTQ community.
• IdentifystrategiestoraisethecompetencyofnursesincaringformembersoftheLGBTQ community.
• Promotestandardizedgender-neutralterminologyanddocumentation.
The consensus from the members of the Assembly was the need for more education and appropriate resources for nurses to provide unbiased and non-discriminatory health care to their LGBTQ patients.
Dialogue Forum #2: Gender Diverse Populations and Dealing with Substance Use Disorder in Nursing addressed the need to identify nurses with Substance Use Disorder (SUD) and to develop and implement interventions for nurses with SUD. Citing Thomas & Ciela (2011), it was noted that the rates of SUD of nurses is similar to the general population, 10%-15% (Report of the Reference Committee, 2016). However, unlike the general population, nurses’ addiction put their patients, as well as themselves, at risk. In addition, itwas noted that theNational Council of State Boards of Nursing (2014)indicated that if nurses suspect SUD in a colleague, they are “professionally and ethically requiredtoreportit.”Itwasalsonotedthatthereareprogramsinsomestates,includingdisciplinary and non-disciplinary programs, that address issues regarding nurses with SUD. Since 1980 ANA has been a strong supporter of the “non-disciplinary treatment programs” (Report of the Reference Committee, 2016).
Participant comments identifying barriers in developing needed programs for SUD addressed:
• Access(treatmentprograms,fundingsources,employersupport)• Stigma• Lackofcoordination(betweennursingassociations,compactstates)• Unwillingnessofpeerstoreport• Lackofstatelegislativesupport(e.g.dept.ofhealth)• Lengthymonitoringinsomeprograms• Legalissues• Challengesfindingre-employmentopportunities• LackofeducationonSUD
Participant comments identifying potential resolutions to these barriers: • Participatinginsupportgroups• Obtainingfunding• Removingstigma• Helpingwithtransitionfromrecoverytowork• Decreasingstress• Enforcingworkplaceprocessesandpolicies• Providingeducationonstressreductionmeasures• Recruitingnursestoserveaspeerfacilitatorsandtospeakwithstudentnurses• TreatingSUDasachronicdisease• ApplyingtheprovisionsofANA’sCode of Ethics with interpretive Statements • Establishingstateandcorporateprocessesforrecoveryandre-entry• MaintainingtheprivacyofacolleaguewithSUD• Benchmarkingprogramsinprogressthatwork
Participant recommendations for needed resources for nurses to help nurses with SUD:• Develop a toolkit for Constituent/State Nurses Associations (C/SNAs) and
registered nurses• Advocateforfundingfordrugtestingandmonitoringprograms• EducatenursesonhowtoidentifypeerswithSUDandhowtoreportit
• CollaboratemorecloselywithAmericanPsychiatricNursesAssociation(APNA)onresource development
• Improveschoolsofnursingrecoveryprograms• Recognizeandaddresspersonalbiases• Developanationallistoftreatmentcenters• Increasepeermentoringprogramsandalternativedisciplineprograms• Increasevolunteersforeducationandpeermentoring• Developstrongevidence-basedalternativedisciplineprograms• IncreasetheconsistencyoftheprovisionsofImpairedProviderPrograms(lPPs)• Provideguidanceonpeerassistanceandalternativediscipline
Participant comments on the entities needed to partner with ANA on programs or resources to assist nurses with SUD:
• Schoolsofnursingtoincreasesubstanceabuseeducationinnursingprograms• Boardsofnursing• Employers-EmployeeAssistancePrograms• Other state nurses associations and related associations (American Hospital
Association, Visiting Nursing Association)
The Reference Committee reported to the Membership Assembly after discussion on Dialogue Forum #2 and made the following recommendations:
• EngagestakeholderstoexploregapsincurrentresearchandpolicyonSUDinthenursing population.
• Promote strategies toeducate students,nurses,andemployersabout identifyingand reporting suspected SUD across care settings.
• Partnerwithstakeholders todevelopmodelprograms tosupportemployersandnurses before, during, and after treatment for SUD.
In1987NewMexicobecame the third state in the country toestablishadrugdiversion program through a bill conceived by a member of the New Mexico Nurses Association, Courtney Cook and lobbied for by NMNA. For FAQs on New Mexico’s diversion program go to: http://nmbon.sks.com/diversion-program-faqs.aspx
Membership Assembly is a great opportunity for nurses to be a voice at the table but to be at the table youmust have a voice in your professional organization. Iextend a personal invitation to nurses who are not a member of ANA/NMNA to join today and join in this exciting process.
ReferencesAmerican Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver
Spring, MD: Nursebooks.orgNational Council of State Boards of Nursing. (2014). Brochure: What you need to know about
substanceusedisorderinnursing.Chicago,IL:NCSBN.ANA 2016 membership Assembly. Report on the Reference Committee. Dialogue Forum
Recommendations.ProposedRevisionstoPolicy:CriteriaforOrganizationalAffiliate.(June,2016)
President’s Message continued from page 1
Page 4 • The New Mexico Nurse October, November, December 2016
Healthy Nurse, Healthy New Mexico
Camille Adair, RN
The New Mexico Nurses Association (NMNA) celebrated nurse’s week with a workshop on May 6th introducing Healthy Nurse, Healthy New Mexico to almost 200 nurses from around the state. NMNA then formed the Healthy Nurse, Healthy NewMexico Interest Group,reflective of the American Nurses Association’s Healthy Nurse™ priority. (nursingworld.org)
New Mexico’s own Dr. Barbara Dossey, who serves as a committee member for Healthy Nurse, Healthy Nation™ initiative led the nurse’s week celebration with a keynote presentation on Healthy Nurses, Resiliency, and Self Care. As a Nightingale scholar, Dossey gracefully bridged nursing legacy with present goals. She shared Nightingale’s vision from the 1870’s, “that it will take 150 years for the world toseethekindofnursingIenvision…”Thattimeisnow
anditcoincideswith“TheNightingaleInitiativeforGlobalHealth (NIGH),agrassroots,nurse inspiredmovement toincrease global public concern for and commitment to the priority of human health,” for which Dr. Dossey is a founding member. (nighvision.net)
“It will take 150 years for the world to see the kind of
nursing I envision…”
~ Florence Nightingale, 1870s
1870+150
2020!!
In 2005, Dr. Barbara Dossey addressed nursingstudents, in an article from the National Student Nurses Association with questions and insights that are relevant today as we seek to develop our health and wholeness as nurses.
“We are at a time in history where we must transform the health care structure from a disease management industry to a healing system…. How do you want to actively contribute to these dynamic changes that will impact the practice and the image of professional nursing, and the healing of society?”
History is one of the most important aspects of any profession. Modern nursing has a proud heritage through its founder, Florence Nightingale, who lived from 1820 to 1910. Nightingale was a mystic, visionary, healer, reformer, environmentalist, feminist, practitioner, scientist, politician and global citizen. Her achievements are astounding when viewed against the backdrop of the Victorian era, and her contributions to nursing theory, research, statistics, public health, and health care reform are invaluable
and inspirational. As a brave risk-taker, Nightingale possessed uncommon vision, focus, dedication, and commitment. Her tenets of healing, leadership, and global action provide us with her vision
A part of Nightingale’s wisdom resides within each of us. I imagine hearing her voice as she tells each of us to identify our “must” and to fight for a health care system driven by the needs of patients. She would encourage all of us to unite in order to actualize our visions. Nightingale, the master networker, would want us to know who our elected officials are and how to best educate them so that they can develop effective legislation for health care reform.
Exciting work lies ahead. How are we going to write our chapter of nursing history as the beginning of the 21st century? What is our role at the local, national, or international level, and in the health care system?
What seeds are we going to plant for others? What is our next productive, innovative and creative endeavor? I wish you the best in your healing journey and finding your ‘must!’ ” (NSNA.org)
Nightingale was an advocate for experiential learning and defined training for nurses as “teaching the nurse to teach people to live.”
Florence Nightingale was an early advocate for Healthy Nurse, speaking to the health and wellbeing of nurses as the foundation of professional practice, as role models for our families, colleagues, patients and communities and in living a good life.
InaletterdatedMay23,1873,Nightingalewrote“The world, more especially the Hospital world, is in such
Florence Nightingale on Healthy Nurse
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October, November, December 2016 The New Mexico Nurse • Page 5
Healthy Nurse, Healthy New Mexico
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a hurry, is moving so fast that it is too easy to slide into bad habits before we are aware.”
We can imagine the exponential growth and change in pacefrom1873tothepresent.Itisclearthatourmodernhealthcareculturerequiresustoprioritizewithvigilance,our own health and wellbeing.
As nurses, each 3.6 million of us are called to do the reflective, sensitive and individual work of developing self-awareness, setting intentions that are aligned with our values and directing our daily and over arching life choices accordingly. The legacy and words of Florence Nightingale and the unconditional dedication to nursing by Barbara Dossey support us on our journey as we ask the questions, who we are? Where we are going? How do we get there?
The following Florence Nightingale quotes were compiled and generously shared by Nightingale scholar Barbara Dossey, PhD, RN, AHN-BC, FAAN.
“Health is not only to be well, but to use every well power we have.”
“Year by year our numbers increase. We are becoming a large band. See that we are banded
together by mutual good will: and remember that the conduct of each member reflects credit or
discredit on the whole. We cannot isolate ourselves if we would.”
Every feeling, every thought that we have, stamps a character upon us, especially in our year of training,
and in the next year or two.”
“Nursing should not be a sacrifice, but one of the highest delights of life”
“Quiet in our own rooms (and a room of your own is specially provided for each one here) — we have bustle every day — a few minutes of calm…— how
indispensable it is, in this every increasing hurry of life! When we live ‘so fast’ do we not require a breathing time, a moment or two daily, to think where we are going, — at this time, especially,
when we are laying the foundation of our afterlife — in reality, the most important time of all?”
“To each and to all I wish the very highest success in the widest meaning of the word in the life’s work
you have chosen. . . We hear much of “Associations” now. It is impossible indeed to live in isolation: we
are dependent upon others for the supply of all our wants, and others upon us. Every Hospital is
an “Association” in itself. We of this School are an Association in the deepest sense, regulated — at least we strive towards it — on high & generous
principles: through organizations working at once for our own & our fellow Nurses’ success. For, to make progress possible, we must make this
inter-dependence a source of good; not a means of standing still. All “Association” is organised
“inter-dependence.” We must never forget that the ‘Individual’’ makes the Association. What the
Association is depends upon each of its members”
This column is dedicated to the health and wellbeing of nurses in New Mexico and will include interviews, articles, resources and statewide events contributing to an emergent and continuing focus on strengthening the nursing profession from within.
Please take the time to participate in the Healthy Nurse™ ANA Health Risk Appraisal at www.anahra.org.
American Nurses Association has developed this Health Risk Appraisal (HRA), in collaboration with PfizerInc,specificallyfornursingstudents(enrolled inanursingprogram leading to RN licensure) and registered nurses. It isyourchancetoassessyourpersonalandprofessionalhealth, safety, and wellness risks and compare your results to ideal standards and national averages. A web wellness portal attached to your responses allows you to gain access to further resources. Aggregate data collection allows for top nursing health, safety, and wellness issues to be identified and addressed. The HRA is free, HIPAA-compliant, secure, and easy to use. Visit www.anahra.org today.
If you are interested in Healthy Nurse | Healthy New Mexico, please visit nmna.org and click on the Healthy Nurse NM tab, visit us on Facebook, or contact the NMNA office to learn more about becoming part of the NMNA Healthy Nurse Interest group.
Sources: Dossey, B. (2000). Florence Nightingale: Mystic, visionary, healer.
Philadelphia: Lippincott, Williams & Wilkins.Dossey, B. M., Selanders, L. C., Beck, D. M., & Attewell, A.
(2005). Florence Nightingale today: Healing, leadership, global action. Washington, DC: NurseBooks.Org.
Dossey, B.M. & Keegan, L. (2008). Holistic Nursing: A Handbook for Practice (5th ed). Sudbury, MA: Jones & Bartlett.
DosseyDossey.comNSNAIMPRINT|www.nsna.org 57 February March 2005Nighvision.net
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Page 6 • The New Mexico Nurse October, November, December 2016
Issues of LiabilityNursing Liability and
Inter-Professional Communications
Dr. Karen L. Brooks, Esq., EdD, MSN RN
The following segment on nursing liability addresses an erroneous belief that if a nurse relies upon inter-professional communications with regard to patient care, the nurse will be able to avoid lawsuits and legal entanglements. This is also the second column in a series on liability concerns and insurance myths that can adversely affect the decision to protect (insure) one’s nursing license.
FAQ: How can I be named in a lawsuit and why do I need liability insurance if I rely upon verbal inter-professional communications?
The New Mexico Nurse Practice Act requires nurses to make reasonable, professional decisions in any and all matters pertaining to patient care treatments and services. In professional nursingpractice, the nurse must critically think, be situationally aware, while also being cognizant ofwhen and how to engage the chain of command. For instance, since not all orders are correct, the nurse should question an order that a nurse should know to be dangerous. Communications may be inaccurate. And patient advocacy is required. Merely following policies and orders may not excuse a nurse for actions or inactions that harm a patient. Consider, also, that the nurse is a member of a health care team. This means that the nurse receives various forms of information and communications from other team members. Such exchanges are essential to the inter-professional discourse that is expected and required by a healthcare organization. Somecommunications that the nurse receives may be incomplete or inaccurate.
As a hypothetical, a nurse working on a medical surgical area receives a verbal report from the emergency department indicating that a patient has already received a medication. In fact themedication has not been given to the patient. There is no documentation in the record that the patient received the medication in the emergency department. The nurse receiving the patient on the medical surgical unit fails to review the medication record and does not give a medication (relying upon verbal report that it was administered in the emergency room). Consequently, the patient sustains harm. Innotpursuingthediscrepancybetweentheverbal report and the lack of documentation in the patient record, the nurse may find herself or himself named in a negligence claim. Further, the nurse could be terminated, could be reported to the state boardofnursingand/orthehealthcareorganizationmight seek to recover its damages that it could be forced to pay because of the nurse’s omission.
Without liability insurance coverage, the nurse has no advocacy with which to deal with any of the aforementioned consequences. All of these legal machinations can occur because the nurse engaged, at the outset, in what appeared to be reasonable inter-professional communications with another teammember (receiving a verbal report). It shouldalso be noted, for this hypothetical, that the interests of the nurse and the healthcare organization areadversarial.
Dr. Karen L. Brooks, Esq., EdD, MSN RN provides this column as an active member of the New Mexico Nurses Association. Dr. Brooks is the Graduate Lead Nursing Faculty (Remote: Santa Fe, New Mexico) within the College of Online and Continuing Education for Southern New Hampshire University.
Ifyouhavequestionsyouwouldliketosubmitforthis column please send them to: [email protected]; if you have questions about your own liability insurance coverage and needs you may also call NMNA at: (505) 471-3324.
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October, November, December 2016 The New Mexico Nurse • Page 7
Bedside Shift Report – A GAME CHANGER for Nurses and the Patient Experience
Penny Beattie, RN, DNP
The Presbyterian Healthcare Services (PHS) Office of Patient Experience and PHS’s Nursing Leadership led efforts to implement the Bedside Shift Report process. The Report ensures that patients and families are included in the exchange of information between shifts by being involved in conversations held at the bedside between oncoming and exiting nursing staff. Bedside Shift Report is active in all eight Presbyterian hospitals.
Research shows that when patients are engaged in their health care, it can lead to measurable improvements in safety and quality (AHRQ, 2013). Likewise, ineffective handoffs have been identified as barriers to safety and quality. Inter-shift reports, occurring two to three times aday set up a potential for miscommunication, patient harm, or neglect (Thomas, 2012). The Joint Commission originally established improved “effectiveness of communication among caregivers” as a National Patient Safety Goal in 2006. (Joint Commission, 2008)
Using quality and Lean Six Sigma process-improvement techniques, a project team was created and led by Linda Marquez,RN,aProcessExcellenceBlackBelt,andnursingleader. The group consisted of volunteer staff nurses, clinical educators and nurse leaders. The team developed a simple bedside shift report process, standard work, training, an implementation plan, competency validation tool and an audit process. The new process was implemented in April 2015 in Presbyterian Hospital’s Adult Medicine and Post-Surgical service lines. Adoption of this best practice was accepted and appreciated significantly by patients, families andnursing staff. It allowed fordevelopmentof a sharedmental model between nursing staff and patients and families.
Literature reports nurse communication as the rising-tide measure to improve patient satisfaction and safety (PressGaney, 2013). PHS had implemented several national
best practices designed to improve performance in communication. This included the Communication with Nurses dimension of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient surveys; however, appreciable improvement was not seen. With the implementation of Bedside Shift Report, the pilot patient units have seen approximately 20 points of improvement.
Penny Beattie, RN, DNP is the Assistant Chief Nursing Officer for Presbyterian Hospital.
This column is a new offering to NM nurses on emerging best practices. If you have emerging practices you want to highlight, please contact the NMNA office at (505) 471-3324.
ReferencesAHRQ. (2013, June). Guide to Patient and Family Engagement
in Hospital Quality and Safety. Retrieved from Agency for Healthcare Research and Quality: www.ahrq/professionals /systems/hospital /engagingfamilies / guide.html
Evans, D. G. (2012). Bedside shift-to-shift nursing report;Implementation andOutcomes.MedSurg Nursing, 281-292.
Joint Commission. (2008). FAQs for the 2008 National Patient Safety Goals. Retrieved from National Patient Safety Goals: www.jointcommissopn.org/satndards_information/npsgs.aspx
PressGaney. (2013). Performance Insights. Retrieved from PressGaney: http://images.healthcare.pressganey.com/Web/PressGaneyAssociatesInc/Communication_With_Nurses_May2013.pdf
Thomas, L. &.-P. (2012). Blending Evidence and Innovation.Improving Intershift Handoffs in a Multihospital Setting.Journal of Nursing Care Quality, 116-124.
CROWNPOINT HEALTHCARE FACILITY
Crownpoint Healthcare Facility is a thriving hospital in the desert of New Mexico; and part of the Indian Health Service. Our facility offers Emergency, Urgent, OB and general inpatient and outpatient services. We are looking for nurses that are adventurous, talented, and gentle and want to give culturally sensitive care.Our facility is Baby Friendly Certified. Our team manages a Level III Trauma ER. We care for the patients that hold on to their traditional customs and want to live in harmony with Mother Earth.Our back yard is Chaco Canyon National Park which is only one of many wonders surrounding Crownpoint, NM.We are a scholarship placement site for National Health Service Corp. and offer recruitment and retention incentives.
We encourage you to consider working with us. Apply at www.usajobs.gov. We will answer questions you have by calling (505) 786-6213 Human Resource; or (505) 786-6262 Nursing Director.
NOW HIRING
Immediate Employment Opportunities for Registered Nurses in the following Departments:
• Nursing Administration • Emergency Department• Med/Surg/Tele • Joint Center • ICU • Inpatient Rehab
• Operating Room • Behavioral Medicine (Psychiatric) • Cath Lab
To be the organization where patients choose to come, physicians want to practice, and people want to work.
We are a growing hospital in beautiful south central New Mexico.
At Gerald Champion Regional Medical Center, we truly value the impact our Nurses have on our patients. Because of the need in our region we are proud to announce our expansion of our Behavioral Medicine Unit which is now open with a total of 38
beds! We have also extended our services within the region to include Wound Care, Inpatient Rehabilitation, Cath Lab and Diabetic care.
Feel the difference of being closer to patients, to the community and to what matter’s most. Join our Team at Gerald Champion Regional Medical Center
Visit our website at www.gcrmc.org to apply.Contact Noellen Rogers at [email protected] for questions.
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Page 8 • The New Mexico Nurse October, November, December 2016
The Recovery Enhancement for Addiction Treatment Act and the Comprehensive Addiction and Recovery Act
Kristen Yawea, MBA, BSN, RNC
ISSUE SUMMARY: Nurses and advanced practice nurses currently practicing remain in a pivotal role to provide effectual health care change while addressing the opioid epidemic at a national and state level. H. R. 2536- The Recovery Enhancement for Addiction Treatment Act (TREAT Act) and S. 524- The Comprehensive Addiction and Recovery Act (CARA Act) seek to minimize the discrepancy in health careresourcesthroughtheutilizationofmedication-assistedtreatment (Congress, 2016). As nursing professionals, there remains an indispensable need for advanced practice nurses to collaborate with other providers
in mitigating the opioid epidemic by prescribing Buprenorphine, thus increasing access to opioid agonist treatment. The enactment of key provisions provides that opportunity after a long fought effort by ANA and AANP at the Federal level with the strong support of state nursing associations.
BackgroundThe TREAT Act has four principal provisions. Qualifying
providers will be allowed to currently treat 100 patients per year instead of only 30 patients with narcotic prescriptive authority for the management of opioid-dependent individuals (Congress, 2016). After one year, qualifying providers will be able to request endorsement to treat
an unrestricted quantity of patients per year in abidance with specific guidelines (Congress, 2016). Moreover, the definition of a “qualifying provider” is seeking amendment to include a board certified in addiction medicine physician and/or a nurse practitioner with a state license to prescribe schedule III thru V pain medications in an authorized practice location, and an individual who has completed specialized training in opioid use disorder treatment (Congress, 2016). Lastly, the act requires the Comptroller General to evaluate the TREAT Act’s efficacy over a defined timeframe (Congress, 2016). The TREAT Act was presented to the House of Representatives on May 21st, 2015 by Representative Brian Higgins of New York, then referred on June 16th, 2015 to the Subcommittee on Crime, Terrorism, Homeland Security, and Investigations, and isawaiting further proceedings at this time (Congress, 2016).
The CARA Act allows the Secretary of Health and Human Services (HHS) to assemble a Pain Management BestPracticesInter-AgencyTaskForceforthedevelopmentand evaluation of best practices regarding pain treatment to establish an approach for executing these best practices (Congress, 2016). Furthermore, this task force will be assigned to assess and identify the requirement for, development of, and accessibility of medical alternatives to opioid medication with similar effects to opium (Congress, 2016). The act also sanctions the Attorney General and the Secretary of Health and Human Services to offer grants specifically addressing the nation’s opioid epidemic that involve both prescription abuse and heroin use by enhancing collaboration between the Department of Justice (DOJ) and substance abuse entities; developing and expanding opioid abuse programs; training first responders to administer Naloxone; and examining unlawful opioid distribution behaviors (Congress, 2016). This bill is a revision to the Omnibus Crime Control and Safe Streets Act of 1968 (Congress, 2016). Additionally, the act was introduced into the Senate on May 12th, 2015 by Senator Sheldon Whitehouse of Rhode Island andwas signed into lawbyPresident Obama on July 22nd, 2016 after passing the Senate and the House of Representatives (Congress, 2016).
Relevance for New MexicoNew Mexico remains amongst the highest in the nation
in prescription and illicit opioid use and abuse, and more significantly, overdoses (Gallagher, 2016). 1.75 million Opioid prescriptions were written for New Mexicans, amounting to approximately one per person in New Mexico in 2014 (Gallagher, 2016). Opioid use disorder, as described in the DSM V, can be described as “a fundamental neurological disease that affects brain reward, motivation, memory, and the related circuitry” (Baird, 2015, p. 213). Moreover, for the principal portion of a decade, New Mexico has been positioned as either No. 1 or 2 in the United States for drug overdose deaths, with 540 deaths in 2014 and 492 deaths in 2015, making this the foremost cause of injury and death in New Mexico (Gallagher, 2016). These deaths nationwide exceed motor vehicle crashes, homicides, and falls combined with an average of 114 individuals passing away each day from drug overdoses (Rundio, 2015). This significant health and social issues led the U. S. Surgeon General, Dr. Vivek Murthy, to visit one of New Mexico’s substance use program facilities in Albuquerque as a national tour to promote awareness and seek further
We are currently accepting applications for Registered Nurses in several of our departments/units, including:
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October, November, December 2016 The New Mexico Nurse • Page 9
understanding regarding our own state’s opioid epidemic (Brunt, 2016). President Obama requested the sum of $1.1 billion in legislative funding to address this epidemic nationally, of which $920 million in funding was assigned to expand medication-assisted treatment access (Uyttebrouck, 2016). Specifically, $1.76 million was awarded to five New Mexico clinics in March of 2016 for medication-assisted treatment access to increase the number of qualifiedproviderswhospecializeinsubstanceusedisordertreatment(Uyttebrouck,2016).These medication treatment options include Naltrexone, Methadone, and Buprenorphine (Uyttebrouck, 2016). Additionally, further legislative funding and national attention has been assigned to the general public’s access of Naloxone in the event of an opioid overdose as a harm-reduction initiative (Uyttebrouck, 2016). Access to Naloxone in New Mexico is becomingincreasinglypublicizedaswell,withmorethan22pharmaciescarryingthelife-saving medication in Bernalillo County (Uyttebrouck, 2016).
The Role of Advanced Practice Nurses in Prescribing BuprenorphineSo how do the TREAT and CARA Acts apply to New Mexico and more specifically, to
advanced practice nurses in New Mexico? Advanced practice nurses were omitted from prescribing Buprenorphine for the detoxification and further opioid abuse treatment with the passing of the Drug Addiction Treatment Act (DATA Act) of 2000 (Rundio, 2012). Yet, at the time advanced practice nurses retained the capacity to prescribe this medication for chronic pain (Rundio, 2012). Moreover, many advanced practice nurses facilitated every treatment aspect regarding opioid use disorders in their patients, however, these advanced practice nurses were required to rely on a qualified physician to prescribe the medication they were monitoring within their own practices (Tierney, Finnell, Naegle, LaBelle, & Gordon, 2015). In August of 2015, 13 United States Senators composeda proposal addressed to the Department of Health and Human Services Secretary imploring the Secretary to consider the role of the advanced practice nurse surrounding Buprenorphine treatment in light of the nation’s opioid epidemic and as a compassionate evidence-based method to improve patient outcomes (Tierney et al., 2015). More recently, the ability for advanced practice nurses to prescribe Buprenorphine has constituted the groundwork of many research and quality improvement endeavors (Tierney et al., 2015). ItisanticipatedthepassingoftheTREATActandenactmentoftheCARAActwillopenthe door for advanced practice nurses to become “qualifying providers” who function independently to prescribe medication-assisted treatment including Buprenorphine along with their physician counterparts. Furthermore, the implementation of such will be considered a “best practice” initiative in mitigating the gap between the health care needs of those suffering from opioid use disorders and access to these health care services. At the time of submission, a specific timeline highlighting the sanctioning of advanced practice nurses to prescribe Buprenorphine has not become publicly transparent. Please refer any questions regarding this implementation to the New Mexico Nurses Association.
Recommendation: To meet the access needs of those suffering from opioid use disorders in acquiring medication-assisted treatment, recommendations exist to ensure
advanced practice nurses are practicing to the greatest extent of their scope of practice in New Mexico with the appropriate education and training to prescribe and monitor Buprenorphine treatment (Strobbe & Hobbins, 2012). This initiative comprises a crucial segment of the nursing profession’s comprehensive care intention while reducing the morbidity and mortality associated with opioid use disorders. Such recommendations include a current nursing license; a Drug Enforcement Administration (DEA) Certificate and an amended DEA license that sanctions the capacity to prescribe Buprenorphine; specialized certification as a Certified Addictions Registered Nurse- Advanced Practice(CARN-AP); and the completion of eight hours of opioid use disorder treatment training (Strobbe & Hobbins, 2012). This recommendation greatly augments the qualified provider pool and access for individuals suffering from opioid use disorders to seek medication-assisted treatment.
ConclusionThe role of the advanced practice nurse regarding the ability to prescribe
Buprenorphine and a subsequent reliance on the passing of the TREAT Act and the implementation of the CARA Act into advanced nursing practice remains ambiguous. Yet, there is hope the federal legislature and health care entities will entertain this as a viable solution in narrowing the medication-assisted treatment gap, thus the nation’s opioid use disorder epidemic. Let us hope the TREAT Act will come to pass by Congress and the CARA Act will be commissioned within the role of advanced practice nurses imminently.
Kristen Smith-Yawea RN, BSN is an active member of the New Mexico Nurses Association and the NMNA Government Relations Committee. She is currently pursuing her DNP through NMSU.
TREAT Act continued on page 10
“Your Strongest Ally to Conquer Cancer”
The New Mexico Cancer Center is operated by New Mexico Oncology Hematology Consultants, Ltd. (NMOHC), an independent physician-owned
practice in Albuquerque, New Mexico. Founded in 1987, the Cancer Center is an independent practice that focused first on patients and
their needs. Since opening our doors, our goal has always been to treat patients the way we want to be treated ourselves by providing quality,
compassionate care. New Mexico Cancer Center provides care to one in three New Mexicans facing cancer. We are a leader in providing cutting-
edge treatment for adult cancers and blood-related disorder, and we provide care in: Albuquerque, Gallup and Silver City, NM.
New Mexico Cancer Center seeks to hire individuals who are
committed to helping us provide a healing environment that supports continuous patient recovery. We are caring and dedicated cancer
specialists who use cutting-edge care in our state-of-the-art facility.
Our Human Resources team looks for candidates – from clinical to administrative – who share our compassion and commitment to patient
care. We offer very competitive salaries and excellent benefits. Relocation packages are available for some positions. If you are interested in RN
positions at NMCC submit your resume/cv to [email protected].
www.nmcancercenter.org
Now Seeking RN OpportunitiesCase Management • ER • ICU • Med/SurgOB • OR • Outpatient Clinics • PACU • PHN
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RMCHCS is an EEOC Employer
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Contact Brian LalioHuman Resources Generalist/Recruiter
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View our current openings and/or submit an application online at:
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Rehoboth McKinley Hospital is recruiting for the following nursing positions: OR (Circulating & PACU) Labor & Delivery/ICU Emergency Room Home Health & Hospice
We offer a great working environment and competitive compensation package including relocation.
Page 10 • The New Mexico Nurse October, November, December 2016
CNM Pinning Ceremony was held August 5th and Jackie Gapp, outgoing President of the CNM Student Nurses Association addressed the
graduates and their families and friends.
Student ForumReferencesBaird, C. (2015). Role of Medication in the Treatment of Opioid Use Disorders. Journal of
Addictions Nursing,26(4),213-216.DOI:10.1097/JAN.0000000000000101Brunt, C. (2016, June 15). Surgeon General Visit Targets Opioid Abuse. Albuquerque Journal, p.
C1-C2.Congress. (2016). H. R. 2536- TREAT Act. Retrieved on June 12th, 2016 from https://www.
congress.gov/bill/114th-congress/house-bill/2536Congress. (2016). S. 524- CARA Act. Retrieved on June 15th, 2016 from https://www.congress.
gov/bill/114th-congress/senate-bill/524Gallagher, M. (2016, June 11). Responding to the Opioid Scourge. Albuquerque Journal, p. A1-
A2.Rundio, A. (2012). Buprenorphine Prescribing by APRNs. Journal of Addictions Nursing, 23, 80-
81.DOI:10.3109/10884602.2011.648735Rundio, A. (2015). The Comprehensive Addiction and Recovery Act of 2014. Journal of
Addictions Nursing,26(1),51-52.DOI:10.1097/JAN.0000000000000064Strobbe, S. & Hobbins, D. (2012). The Prescribing of Buprenorphine by Advanced Practice
Addictions Nurses. Journal of Addictions Nursing,23,82-83.DOI:10.3109/10884602.2011.649026
Tierney, M., Finnell, D., Naegle, M., LaBelle, C., & Gordon, A. (2015). Advanced Practice Nurses: Increasing Access to Opioid Treatment by Expanding the Poolof Qualified Buprenorphine Prescribers. Substance Abuse, 36, 389-392. DOI:10.1080/08897077.2015.1101733
Uyttebrouck, O. (2016, April 6). City Promotes Overdose Drug to Save Lives. Albuquerque Journal, p. A4.
Uyttebrouck, O. (2016, May 1). Fighting Drugs with Drugs: Funds for Addiction-treating Meds Flowing into New Mexico. Albuquerque Journal, p. A1, A7.
TREAT Act continued from page 9
Registered Nurse Positions (FT/PRN)Med/Surg | L&D/Peds | Cardiovascular | EmergencyCCU/ICU | Surgical Services | Case Management | Quality
HR Recruiter: 575-624-8793Apply at www.enmmc.com
Submit your application at enmmc.com under Job Opportunities. EOE. ENMMC provides competitive salaries, sign-on bonus, relocation, housing allowance and an excellent benefits package. ENMMC is a drug free employer
CareerOpportunities
If you believe that better health care starts with you, come grow with us
Nursing Opportunities Available• ER / Medical-Telemetry Unit Nurse Supervisor
• Emergency Room Nurse • Medical / Telemetry Unit Nurse• Outpatient Clinic Nurse
Sage Memorial Hospital is located in Northeastern Arizona, Ganado, Arizona
For more information contact: Ernasha McIntosh, RN, BSN, IDON, 928-755-4501, [email protected].
Applications available at http://sagememorial.com/careers/
Submit applications to the Human Resources Department,Fax#: 928-755-4659, [email protected]
October, November, December 2016 The New Mexico Nurse • Page 11
ANA/New MexicoMembership ApplicationFor other information, please contact ANA's Membership Billing Department at (800) 923-7709 or email us at [email protected].
Essential Information:
City/State/Zip Email Address
Employer Current Employment Status: (e.g. full-time, part-time, per diem, retired)
Type of Work Setting: (e.g. hospital, clinic, school) Current Position Title: (e.g. staff nurse, manager, educator, APRN)
Practice Area: (e.g. pediatrics, education, administration) RN License # State
FaxCompleted application with credit cardpayment to (301) 628-5355
WebJoin instantly onlineVisit us at www.JoinANA.org
MailANA Customer & Member BillingP.O. Box 504345 St. Louis, MO 63150-4345
First Name/MI/Last Name
Mailing Address Line 1
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Professional Information:
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If paying by credit card, would youlike us to auto bill you annually?
Please Note — American Nurses Association (ANA) member ship dues are not deductible as charitablecontributions for tax purposes, but may be deductible as a business expense. However, the percentageof dues used for lobbying by the ANA is not deductible as a business expense and changes each year.Please check with ANA for the correct amount.
Dues ..........................................................................................$
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Total Dues and Contributions ..........................................$
Authorization Signatures:
Monthly Electronic Deduction | Payment Authorization Signature*
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*By signing the Monthly Electronic Payment Deduction Authorization, or the Automatic AnnualCredit Card Payment Authorization, you are authorizing ANA to change the amount by giving theabove signed thirty (30) days advance written notice. Above signed may cancel this authorizationupon receipt by ANA of written notification of termination twenty (20) days prior to deduction datedesignated above. Membership will continue unless this notification is received. ANA will charge a $5fee for any returned drafts. ANA & State and ANA-Only members must have been a member for sixconsecutive months or pay the full annual dues to be eligible for the ANCC certification discounts.
Credit Card Information:
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Ways to Pay:
CheckCredit Card
Checking Account Attach check for first month’s payment. Please make checks payable to ANA.
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How did you hear about ANA? Colleague Magazine Online Other: __________________________
Go to www.JoinANA.org to become a member and use the code: NMX14
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*Nurses must already hold an RN license before becoming members of ANA
Joint Membership $238.00 $20.34
Reduced 50% reduction in membership fees $113.00 $9.92Not employed Full Time Student New licensee within 6 months of first licensure62 y/o and not earning more than social security allows
Special—75% reduction in membership fees $56.50 $5.21> 62 y/o and not employed or Totally disabled
Yearly Monthly
Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system comprised of eight hospitals, a statewide health plan, and a growing multi-speciality medical group. Founded in New Mexico in 1908, it is the state’s largest private employer, with approximately 11,000 employees. We have a variety of openings for nurses in inpatient and outpatient settings, including:
• EmergencyDepartment (Job ID # 169, 694)• MedSurg/ER (Job ID # 237, 4008)• ProgressiveCare (Job ID # 109)• SkilledNursing (Job ID # 2419)• OperatingRoom (Job ID # 519, 1379, 4811, 3588,
316, 3788)• RecoveryRoom (Job ID # 2179)• ICU (Job ID # 293, 1279, 730)• OB/L&D (Job ID # 392, 1790)• Outpatient (Job ID # 593, 598, 3489)• ManagerNursingMedSurg/ER (Job ID # 3995)• LPNs
We offer competitive salaries, sign-on bonuses, relocation, day-one benefits packages, and wellness programs.
To learn more about career opportunities at Presbyterian contact Tammy Duran-Porras at [email protected] or (505) 923-5567, or Janna Christopher at [email protected] or (505) 923-5239.
Makeeverymomentofyourlifecountformorehere.
www.phs.org/careers
AA/EOE/VET/DISAıLED. PHS is committed to ensuring a drug-free workplace.
NURSING JOBS AT SOMBRILLOSeeking FT MDS RN or LPN, FT ADON RN or LPN, PRN RN, LPN/LVN, and CNA positions all shifts. All nursing positions given differential pay for nights and weekends.
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Please call Ann at 505-661-0066 or e-mail [email protected]
Page 12 • The New Mexico Nurse October, November, December 2016
At Lovelace, we celebrate our nurses every day.
NOW ACCEPTING APPLICATIONS FOR RNS IN THE FOLLOWING SPECIALTIES:•CriticalCare•CoronaryCare•EmergencyRoom•Neuro•Med/Surg• IntermediateCare•SurgicalServices•BehavioralHealth• InterventionalRadiology•Rehab
LOVE WHAT MATTERS•Flexibleschedules• Shiftdifferentials•EducationIncentives• Sign-onbonus•CertificationPay•Healthinsurancediscountsandmuchmore!